Provider Demographics
NPI:1912925280
Name:MEYER, DANIEL RAYMOND (PA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAYMOND
Last Name:MEYER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 EGRET CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-8678
Mailing Address - Country:US
Mailing Address - Phone:970-985-8386
Mailing Address - Fax:
Practice Address - Street 1:4102 SAWMILL MESA RD
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-9158
Practice Address - Country:US
Practice Address - Phone:970-874-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA-2210363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical